Provider Demographics
NPI:1649373770
Name:TING, VALERIE JEAN (ARNP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:JEAN
Last Name:TING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 BOSKYDELL RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-7622
Mailing Address - Country:US
Mailing Address - Phone:618-549-7576
Mailing Address - Fax:
Practice Address - Street 1:3839 BOSKYDELL RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62903-7622
Practice Address - Country:US
Practice Address - Phone:618-549-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41-195392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL41195392OtherAPN LICENSE